Routine cord blood testing (ABO, Rh, DAT)

[GilTphoto]

We do all cords. Part of the reason is for detecting low incidence antibodies. If the mother is ABO compatible with the baby, and her antibody screen is negative, but the baby has a positive DAT, a low incidence antigen from the father should be suspected.

True, they could just watch for icterus, but sometimes it takes a few days for the bilirubin to build up, and they would rather know earlier.

[Malcolm Needs ☆]

Okay, I understand that GilTphoto, but when the feto-maternal ABO is compatible, and the mother is not known to have any atypical alloantibodies directed against the major blood group antigens, how many positive DAT's do you actually see that are, a) due to an antibody in the mother that is directed against a low incidence antigen expressed on the baby's red cells, and how many of these result in clinical, as apposed to sub-clinical HDN? I suspect it is disappearingly few.

It is rather the same situation as that with the differentiation between delayed haemolytic transfusion reactions and delayed serological transfusion reactions; the latter being commonly detected in the laboratory, but being of no clinical significance whatsoever.

[Malcolm Needs ☆]

Hi Mary,

The article has just arrived safe and sound on my desk.

Thank you so much.

BBT just gets better and better!

Malcolm

[debB]

we do group and DAT on all babies born at our hospital -- the neonatologist thinks of it a a protective measure.. so they dont miss something.. and the nursing staff want it because there is a place for the group on the discharge summary - but we get paid for the work we do so effectively it is a money making venture for the lab anyway.

[Mary**]

I am glad it got to you.

[Malcolm Needs ☆]

:mad:

we do group and DAT on all babies born at our hospital -- the neonatologist thinks of it a a protective measure.. so they dont miss something.. and the nursing staff want it because there is a place for the group on the discharge summary - but we get paid for the work we do so effectively it is a money making venture for the lab anyway.

This is exactly what I was getting at.

The neonatologists think it is a protective measure, but it tells them nothing. They also order it on the grounds that they don't want to miss something when, if they see the baby becoming icteric or even prove that the baby is becoming icteric by asking for serial bilirubin levels to be performed (also totally unnecessary, unless icterus is a real possibility - and I don't mean through prematurity) then is the time to investigate the cause.

The nursing staff want it because there is a place on the discharge summary for the blood group! My goodness, I'd be glad to get a request form into my place that had every box filed in; not just the ones that are absolutely necessary for patient identification, where to send the results (not, I might add, filled in on every request form!) and what tests are required (ditto).

It either shows a total lack of training on the part of the neonatologists and the nursing staff, or a total disregard for the reasons such tests should really be requested.

It also shows a total lack of regard for the person (or insurance company) who is having to pay for the tests, and, I am sorry to say this, so does your own last comment (albeit, it may have been written in jest - or, at least, I hope so).

Edited May 27, 2009 by Malcolm Needs
I've moderated what I originally wrote.

[debB]

Thanks Malcolm,

yes.. I agree with what you have said... and the last comment was "tounge-in- cheek". ( I am new at this and not sure when to use smly faces :-) )We are actively trying to change practices but.. if the clinician wants those results we will do them (on most cord blood collected in this hospital- we reject quite a few on grounds of mislabelling but that is another story)